States Require Vaccines for Middle Schoolers

A trip to the doctor's office for a series of vaccines used to be a
ritual that only babies and toddlers endured before entering school for
the first time.

But thousands of middle school students will soon be feeling the
sting, too. Several states have recently adopted policies requiring
older students to get immunized before heading back to class.

Florida became the latest state to act when health officials adopted
a regulation last month that requires all 7th graders to get a series
of inoculations--a second dose of the measles vaccine, a series of
three hepatitis B shots, and a tetanus-diphtheria booster--by the time
they enter school in September.

Oklahoma has approved a rule requiring the state's 48,000 7th
graders to have a series of hepatitis B shots before they enter school
next year. Colorado, Hawaii, Maryland, and North Carolina have also
adopted policies in the past few years mandating that middle school
students get inoculated against a range of illnesses, including chicken
pox and mumps.

In part, the states are responding to federal calls to do more to
curb contagious diseases. Spurred by public health concerns over recent
measles outbreaks and the continued prevalence of hepatitis B infection
among young people, a federal immunization advisory panel issued
recommendations last year that state health departments adopt more
rigorous vaccination guidelines.

Health officials also hope that the rules will get adolescents
accustomed to seeking medical care.

Immunizing older children is a way to get adolescents to the doctor
when they're increasingly vulnerable to contagious diseases, said Dr.
Francisco Averhoff, a medical epidemiologist at the federal Centers for
Disease Control and Prevention's national immunization program in
Atlanta and a member of the advisory panel.

While toddlers and elementary-school-age children tend to visit the
doctor fairly regularly, teenagers make up the group that is least
likely to see a medical professional for preventive care, Dr. Averhoff
said. And adolescence is a period when young people often start
engaging in behavior--such as unprotected sexual intercourse--that puts
them at risk for a range of illnesses, like hepatitis B, a highly
contagious virus that damages the liver and is passed through blood or
bodily secretions.

Florida's campaign to inoculate all 7th graders against three
diseases is one of the most ambitious of the new programs, especially
because the infection rates for the diseases are relatively low in the
state, health officials said.

"It wasn't, 'Oh my God, we've got a terrible outbreak, and we've got
to do something,'" said David Adams, a spokesman for the immunization
bureau at the Florida health department. "It's just a good preventative
step to take," he said.

Tricky Implementation

In anticipation of the September 1997 deadline, most Florida school
districts are mounting aggressive campaigns to educate parents about
the vaccination requirement, which affects the estimated 180,000
students who will enter 7th grade next year.

Shelby Morrison, the health director of the Orange County, Fla.,
public schools, said the district is sending home fliers and permission
slips to 10,000 parents. In addition, a coalition of health-care
agencies, fire departments, and hospitals around Orlando plans to
launch a blitz of television and radio broadcasts next month.

Florida health officials recommend that students go to their private
doctors for the vaccines, which are commonly covered under
health-insurance plans. County health departments will also offer the
immunizations to students free of charge. As in other states with
mandatory vaccine programs, children in Florida who are eligible for
Medicaid can get their shots through private physicians and get
reimbursed through the federally funded vaccines-for-children program.
Some doctors may charge a $10 administrative fee.

Even though the program will be widely publicized and inexpensive,
Ms. Morrison is worried that many students will come to school next
fall without proof that they have had their shots. Florida health
officials say that students who do not have a Florida certificate of
immunization that shows they have at least started their series of
shots will not be allowed to enter school in the fall.

Whether officials will be able to enforce the rule, though, is
uncertain. "We simply don't have the clerical staff to call the doctors
and follow up on all of this," Ms. Morrison said. "And you don't want
to over-immunize," she said.

Off Target, Too Risky

Parents' groups in other states have criticized mandatory
immunization programs targeting students of any age. They charge that
the vaccines are inappropriately administered or medically risky.

Last spring, a group of parents in Memphis, Tenn., claimed that the
county's mandatory vaccination program to quell an outbreak of
hepatitis A unfairly targeted black students. A $500 million lawsuit
against the school district and the county health department likened
the shots to a "badge of slavery." District officials countered that
because the student population was 85 percent black, the program could
not be deemed to single out blacks. ("Memphis Parents Seek To Halt Vaccine
Program," May 15, 1996.)

More than 2,000 cases of hepatitis A, which is spread chiefly by
fecal contamination, have been reported in Memphis since 1994.

Some parents, meanwhile, argue that any mandatory vaccine program
can be dangerous to children's health. Parents are often rushed into
signing permission slips without knowing the medical consequences, said
Trina Jones-Hylton, a parent from Oklahoma City. When she took her
10-week-old son to the doctor for the required
diphtheria-pertussis-tetanus shot three years ago, the infant had a
bout of severe seizures that has significantly delayed his development,
she said.

As a member of a group called Dissatisfied Parents Together, Ms.
Jones-Hylton has lobbied against Oklahoma's new mandatory vaccination
program that requires 7th graders to get three doses of hepatitis B
vaccine and a series of DPT shots by September.

"It has gotten to where it's too easy to give these shots, and there
isn't enough regard given to the possible side effects," she said.

Edd Rhoades, the child-health director at the Oklahoma health
department, said last week that parents have a right to exempt their
children from the requirement for medical, personal, or religious
reasons. And, he added, parents are well informed of the risk.

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